| NPI | 1700602398 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRYSTAL THOMAS President 318-216-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| 103TH0100X Psychologist, Health Service | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2024-11-27 |
| Last Update Date | 2025-03-31 |